Bottom Line:
In 2014 he evolved C3 stage AIDS with pre-pyloric gastric ulcer which provoked deformity and pseudotumoral aspect of the gastric outlet.Endoscopic biopsy confirmed CMV infection.CMV infection should be considered as an agent in gastric lesions in HIV-infected patients.

Affiliation: Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil.

ABSTRACT

Background: Cytomegalovirus (CMV) is a common opportunistic pathogen in patients with HIV. It is also a major cause of gastrointestinal ulcers in patients with acquired immunodeficiency syndrome (AIDS). CMV pseudotumor in the stomach is a rare cause of digestive tract obstruction.

Case report: In this study we report a male patient infected with HIV in 2002. In 2014 he evolved C3 stage AIDS with pre-pyloric gastric ulcer which provoked deformity and pseudotumoral aspect of the gastric outlet. Endoscopic biopsy confirmed CMV infection. He underwent Roux-en-Y gastroenteroanastomosis with good recovery.

Conclusions: CMV infection should be considered as an agent in gastric lesions in HIV-infected patients. Roux-en-Y gastroenteroanastomosis is a surgical option for this group of patients, allowing improvements in quality of life and decreasing risks of perioperative complications.

Mentions:
At about the same time, an upper digestive endoscopy (UDE) was performed. UDE showed an ulcer 2 cm in diameter, with deep fibrin in its base, erythematous and swollen edges comprising the pyloric channel, causing difficulty in endoscopic progression into the duodenum (Figure 1). Biopsy demonstrated cytological abnormalities consistent with CMV infection and concomitant presence of Helicobacter pylori (H. pylori) infection (Figure 2). Abnormalities were described such as endothelial cells with foamy cytoplasm and nuclear eosinophilic inclusion compatible with cytopathic viral effect by cytomegalovirus in ulcerated mucosa area. Consequently, the patient was treated with ganciclovir 5 mg/kg twice a day intravenously for 21 days. At the same time, H. pylori infection was treated with amoxicillin, clarithromycin, and omeprazole (triple therapy orally for 7 days).

Mentions:
At about the same time, an upper digestive endoscopy (UDE) was performed. UDE showed an ulcer 2 cm in diameter, with deep fibrin in its base, erythematous and swollen edges comprising the pyloric channel, causing difficulty in endoscopic progression into the duodenum (Figure 1). Biopsy demonstrated cytological abnormalities consistent with CMV infection and concomitant presence of Helicobacter pylori (H. pylori) infection (Figure 2). Abnormalities were described such as endothelial cells with foamy cytoplasm and nuclear eosinophilic inclusion compatible with cytopathic viral effect by cytomegalovirus in ulcerated mucosa area. Consequently, the patient was treated with ganciclovir 5 mg/kg twice a day intravenously for 21 days. At the same time, H. pylori infection was treated with amoxicillin, clarithromycin, and omeprazole (triple therapy orally for 7 days).

Bottom Line:
In 2014 he evolved C3 stage AIDS with pre-pyloric gastric ulcer which provoked deformity and pseudotumoral aspect of the gastric outlet.Endoscopic biopsy confirmed CMV infection.CMV infection should be considered as an agent in gastric lesions in HIV-infected patients.

Affiliation:
Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil.

ABSTRACT

Background: Cytomegalovirus (CMV) is a common opportunistic pathogen in patients with HIV. It is also a major cause of gastrointestinal ulcers in patients with acquired immunodeficiency syndrome (AIDS). CMV pseudotumor in the stomach is a rare cause of digestive tract obstruction.

Case report: In this study we report a male patient infected with HIV in 2002. In 2014 he evolved C3 stage AIDS with pre-pyloric gastric ulcer which provoked deformity and pseudotumoral aspect of the gastric outlet. Endoscopic biopsy confirmed CMV infection. He underwent Roux-en-Y gastroenteroanastomosis with good recovery.

Conclusions: CMV infection should be considered as an agent in gastric lesions in HIV-infected patients. Roux-en-Y gastroenteroanastomosis is a surgical option for this group of patients, allowing improvements in quality of life and decreasing risks of perioperative complications.